CDC has received a report of a 20-month old infant from the San
Francisco area who developed unexplained cellular immunodeficiency
and
opportunistic infection. This occurred after multiple
transfusions,
including a transfusion of platelets derived from the blood of a
male
subsequently found to have the acquired immune deficiency syndrome
(AIDS).

The infant, a white male, was delivered by caesarian section on
March 3, 1981. The estimated duration of pregnancy was 33 weeks;
and
the infant weighed 2850 g. The mother was known to have developed
Rh
sensitization during her first pregnancy, and amniocentesis done
during this, her second, pregnancy showed the fetus had
erythroblastosis fetalis. The infant had asphyxia at birth and
required endotracheal intubation. Because of hyperbilirubinemia,
six
double-volume exchange transfusions were given over a 4-day period.
During the 1-month hospitalization following birth, the infant
received blood products, including whole blood, packed red blood
cells, and platelets from 19 donors. All blood products were
irradiated.

After discharge in April 1981, the infant appeared well,
although
hepatosplenomegaly was noted at age 4 months. At 7 months, he was
hospitalized for treatment of severe otitis media. Oral
candidiasis
developed following antibiotic therapy and persisted. At 9 months
of
age, he developed anorexia, vomiting, and then jaundice.
Transaminase
levels were elevated, and serologic tests for hepatitis A and B
viruses and cytomegalovirus were negative; non-A non-B hepatitis
was
diagnosed.

At 14 months of age, the infant developed neutropenia and an
autoimmune hemolytic anemia and thrombocytopenia. Immunologic
studies
showed elevated serum concentrations of IgG, IgA, and IgM,
decreased
numbers of T-lymphocytes, and impaired T-cell function in vitro.
Following these studies, he was begun on systemic corticosteroid
therapy for his hematologic disease. Three months later, a bone
marrow sample, taken before steroid therapy began, was positive for
Mycobacterium avium-intracellulare. Cultures of urine and gastric
aspirate, taken while the infant received steroids, also grew M.
avium-intracellulare. The infant is now receiving chemotherapy for
his mycobacterial infection. He continues to have
thrombocytopenia.

The parents and brother of the infant are in good health. The
parents are heterosexual non-Haitians and do not have a history of
intravenous drug abuse. The infant had no known personal contact
with
an AIDS patient.

Investigation of the blood products received by the infant
during
his first month of life has revealed that one of the 19 donors was
subsequently reported to have AIDS. The donor, a 48-year-old white
male resident of San Francisco, was in apparently good health when
he
donated blood on March 10, 1981. Platelets derived from this blood
were given to the infant on March 11. Eight months later, the
donor
complained of fatigue and decreased appetite. On examination, he
had
right axillary lymphadenopathy, and cotton-wool spots were seen in
the
retina of the left eye. During the next month, December 1981, he
developed fever and severe tachypnea and was hospitalized with
biopsy-proven Pneumocystis carinii pneumonia.

Although he improved on antimicrobial therapy and was
discharged
after a 1-month hospitalization, immunologic studies done in March
1982 showed severe cellular immune dysfunction typical of AIDS. In
April 1982, he developed fever and oral candidiasis, and began to
lose
weight. A second hospitalization, beginning in June 1982, was
complicated by Salmonella sepsis, perianal herpes simplex virus
infection, encephalitis of unknown etiology, and disseminated
cytomegalovirus infection. He died in August 1982.
Reported by A Ammann, MD, M Cowan, MD, D Wara, MD, Dept of
Pediatrics,
Univeristy of California at San Francisco, H Goldman, MD, H
Perkins,
MD, Irwin Memorial Blood Bank, R Lanzerotti, MD, J Gullett, MD, A
Duff, MD, St. Francis Memorial Hospital, S Dritz, MD, City/County
Health Dept, San Francisco, J Chin, MD, State Epidemiologist,
Calfornia State Dept. of Health Svcs; Field Svcs Div, Epidemiology
Program Office, AIDS Activity, Div of Host Factors, Center for
Infectious Diseases, CDC.

Editorial Note

Editorial Note: The etiology of AIDS remains unknown, but its
reported occurrence among homosexual men, intravenous drug abusers,
and persons with hemophilia A (1) suggests it may be caused by an
infectious agent transmitted sexually or through exposure to blood
or
blood products. If the infant's illness described in this report
is
AIDS, its occurrence following receipt of blood products from a
known
AIDS case adds support to the infectious-agent hypothesis.

Several features of the infant's illness resemble those seen
among
adults with AIDS. Hypergammaglobulinemia with T-cell depletion and
dysfunction are not typical of any of the well-characterized
congenital immunodeficiency syndromes (2), but are similar to
abnormalities described in AIDS (3). Disseminated M.
avium-intracellulare infection, seen in this infant, is a reported
manifestation of AIDS (4). Autoimmune thrombocytopenia, also seen
in
this infant, has been described among several homosexual men with
immune dysfunction typical of AIDS (5). Nonetheless, since there
is
no definitive laboratory test for AIDS, any interpretation of this
infant's illness must be made with caution.

If the platelet transfusion contained an etiologic agent for
AIDS,
one must assume that the agent can be present in the blood of a
donor
before onset of symptomatic illness and that the incubation period
for
such illness can be relatively long. This model for AIDS
transmission
is consistent with findings described in an investigation of a
cluster
of sexually related AIDS cases among homosexual men in southern
California (6).

Of the 788 definite AIDS cases among adults reported thus far
to
CDC, 42 (5.3%) belong to no known risk group (i.e., they are not
known
to be homosexually active men, intravenous drug abusers, Haitians,
or
hemophiliacs). Two cases received blood products within 2 years of
the onset of their illnesses and are currently under investigation.

This report and continuing reports of AIDS among persons with
hemophilia A (7) raise serious questions about the possible
transmission of AIDS through blood and blood products. The
Assistant
Secretary for Health is convening an advisory committee to address
these questions.

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